Lean Six Sigma: A new approach to the management of patients undergoing prosthetic hip replacement surgery

Giovanni Improta, Giovanni Balato, Maria Romano, Francesco Carpentieri, Paolo Bifulco, Mario Alessandro Russo, Donato Rosa, Maria Triassi, Mario Cesarelli

Research output: Contribution to journalArticlepeer-review


Rationale, aims and objectives In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. Methods The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. Results The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). Conclusion This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs.

Original languageEnglish
Pages (from-to)662-672
Number of pages11
JournalJournal of Evaluation in Clinical Practice
Issue number4
Publication statusPublished - Aug 1 2015


  • efficiency of care
  • health care management
  • health economics
  • health services research
  • Lean Six Sigma
  • public health
  • reducing length of stay

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy


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